My Doctor and I talked about:

- My diagnosis

- The fact that I can say NO to the medicine at any time, but I have to tell my doctor.

- The reason my doctor wants me to take the medicine, and the chance of me getting better - or not
getting better - without the medicine.

- The medicine that I will be taking - the dose, when and how I will take it, and about how long I will
need to take it.

- Any other ways to treat my problems.

- The side effects for the medicine and any that might be likely in my case Some medicines may start to hurt my body after I begin taking them, so I may need to have lab
tests to make sure I am safe with these medicines. My doctor will talk with me about this if I am
taking one of these medicines.

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I will talk with my doctor about all my medical problems and any medicine that I am already taking.

Medicine prescribed today by my doctor:

        Medicine Name                    Dose            When                           How                                         

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